Organization
ST. MARY'S INDEPENDENT LIVING EXTENSIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL PIEPER (EXECUTIVE DIRECTOR)
(770) 279-5115
Entity
Organization
Contact information
Practice address
120 GLOSTER RD NW STE 3, LAWRENCEVILLE, GA 30044-4479
(770) 279-5115
(770) 923-2059
Mailing address
120 GLOSTER RD NW STE 3, LAWRENCEVILLE, GA 30044-4479
(770) 279-5115
(770) 923-2059
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
067-R-0388
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
779876528A
—
GA
05
—
779876528B
—
GA
Enumeration date
04/21/2015
Last updated
04/21/2015
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up